Bowel Disorders, Part I: About Gut Disease

Unfortunately, two people dear to me have recently developed ulcerative colitis. Both live in the same household – a hint that the disease has a shared cause, like diet or an infectious pathogen.

Ulcerative colitis is a form of inflammatory bowel disease in which open sores, or ulcers, dot the colon. It often produces bloody diarrhea and abdominal pain.

Ulcerative colitis is closely related to other inflammatory bowel disorders, such as Crohn’s disease. Crohn’s patients have damage to the small intestine as well as colon, but many of the symptoms overlap. It is quite likely that all the inflammatory bowel disorders are essentially the same disease induced by different casts of pathogens.

These diseases probably develop through a hierarchy of causes:

Food toxins damage the intestine and make it leaky to gut bacteria and bacterial proteins.

Malnutrition impairs the immune response to toxins and slows the healing of intestinal injuries. This makes the intestine even more leaky and damaged.

Damaged immunity allows bacteria to penetrate the gut mucosa and infect intestinal cells, and to enter the body and create systemic infections including intracellular infections of immune cells. The immune response to these infections creates an inflammatory environment which makes the gut even leakier. The infections also weaken the ability of the immune system to heal the gut.

Entry of toxins and bacteria into the body leads to autoimmunity. Food toxins conjugate with human proteins and provoke antibodies against the human protein; bacterial proteins that are ‘molecular mimics’ of human proteins engender antibodies that strike both the bacterial and human proteins.

Autoimmunity leads to further damage to the gut and to other tissues, like the thyroid, which are important for immune function and wound healing. Hypothyroidism, for instance, promotes disease progression.

In its early stages, development of the disease may be accelerated by a long course of antibiotics or an infection that causes severe diarrhea. Thesekill healthful gut bacteria and facilitate their replacement by pathogens.

If we prioritize these in terms of damage caused, then ulcerative colitis is an infectious and autoimmune disease, since these two factors do the most severe damage. It is generally unclear which is doing the most damage. Food toxins and malnutrition continue to be secondary sources of damage.

On the other hand, if we prioritize chronologically in terms of the original causes, the disease is originally caused by food toxins and malnutrition and sometimes antibiotics, which cause intestinal damage and infections, followed by autoimmunity.

Multifactorial nature of the disease – and the cure

Given the many factors that contribute to the disease, many steps may need to be taken to cure the disease:

In our view, various dietary and nutritional tactics are critical, with toxin elimination and vitamin D normalization among the most important steps. Most medical treatments are likely to be ineffective if the diet is bad.

Steps to improve gut flora may be essential. This is a fascinating approach which is gradually migrating from alternative medicine to research hospitals. In effect, friendly bacteria become warriors against pathogens on the patient’s behalf.

Medical treatments can be very helpful, and can include antibiotics such as rifaximin to treat infections and thyroid hormone to promote healing and immunity. Extremely popular among doctors is the use of anti-inflammatory drugs to help reduce autoimmune damage. Both antibiotic and anti-inflammatory drugs have dangers however.

This is a complex disease so I’ve decided to split up my discussion into a series of posts. Luckily, almost all of it is equally helpful for other digestive conditions; the same steps will heal acid reflux, for instance.

Part II will deal with the food toxins, how they contribute to inflammatory bowel disease, and how the diet should be altered to minimize its toxin load.

Part III will deal with the nutrients needed for proper gut and immune function, and how malnutrition contributes to the disease and can be repaired.

Part IV will deal with tactics for restoring healthful gut flora. This can itself be a curative therapy for inflammatory bowel disease, as doctors are increasingly realizing. And it is perhaps the easiest (if the ickiest!) of therapies.

Part V will deal with dietary tactics for defeating infections. These can be extremely helpful in overcoming any chronic infectious disease, and there is an undeniable infectious component to ulcerative colitis.

If I haven’t become exhausted, I may add a brief note regarding medical therapies. Doctors have a choice of anti-inflammatory and immunosuppressive therapies appropriate for autoimmune diseases, and antibiotic and probiotic therapies appropriate for infectious diseases. Our bias is in favor of defeating infections; many autoimmune conditions, we suspect, will disappear within months after the infections that spawned them have been defeated.

Hi,
This from a medscape nurses education email:
‘January 12, 2011 — Treatment for 2 weeks with the minimally absorbed antibiotic rifaximin provides long-lasting, significant symptom relief in patients who have irritable bowel syndrome (IBS) without constipation, according to the results of 2 randomized controlled trials reported in the January 6 issue of the New England Journal of Medicine.’

I would have commented under the part 4 of this series, but I can’t get it to open. (weird).

Dear Dr. Jaminet
I have been reading with great interest your posts on gut health. I too have a loved one with ulcerative colitis, my son, who was diagnosed last fall just before his 18th birthday. The GI doc prescribed 6-MP but he was not able to achieve remission and developed liver inflammation so that was discontinued after 7 months. He is now receiving infusions of Remicade, 2 so far. Long story short, 2 days ago, instead of heading off to college as planned, he was in the ER of the local hospital where a catscan showed a kidney stone had developed due to dehydration from the chronic diarrhea.
I have been trying to get him to go to a Paleo-type diet but so far have had minimal success; his GI doc and 2 friends with UC have all told him that diet does not have a major impact on the condition, which is just what he, lover of pizza and pasta that he is, wanted to hear.
Interestingly, our dog, a Collie, developed colitis about a year before our son did (he is treated with a daily sprinkling of Tylan-brand antibiotic powder on his food; this keeps his stool formed though he still has some urgency). Since we had moved from a home with a well to a home with town water 3 years ago, we wondered what, if any, role the change in water supply might have played. The well water tested clean more than once, and the town water of course is treated and presumably also fluoridated.
I would greatly appreciate your thoughts on this.
Thanks,
Suzanne
PS. I have been following the PHD for over 2 months and it has helped me to weather the stress of my son’s illness and my mother’s recent death much better than I would have otherwise. My sincere thanks to you and your wife for sharing your findings.

So sorry about your son. It should be such an exciting time of life for him; I remember how excited I was to go off to college. In suffering perhaps he will mature and find wisdom. “Those that sow in tears shall reap in joy.” A first step toward wisdom is not to put too much trust in doctors, or too little in moms.

At 18, it’s hard not to eat the foods your friends eat. Perhaps your own improving health, or good meals he has when home, may persuade your son to reconsider his diet.

Medically, I think it’s exactly backward — and potentially disastrous — to prescribe immunosuppressive drugs for what is almost always an infectious condition. Rather, antibiotics and probiotics are the therapies I would prescribe. I think he should find a new doctor.

Celiac disease also has to be considered as a possibility. He should give up wheat for a month and see if he improves.

I think the water possibility is a very interesting idea. Well water tends to be mineral rich, treated water mineral-free. It may be that your collie developed magnesium, calcium, selenium or other mineral deficiencies after the move. Selenium is very important for gut health, so is magnesium. You might try grinding up a multimineral supplement into his food.

The other possibility is some toxin in the water, like chlorine or fluorine. Filtering the water, as with a Britta filter, is something I would highly recommend. Iodine supplementation would also help, as it drives out other halogens. This has to start low and be introduced very gradually to prevent a reactive hypothyroidism. Scale human doses by body mass for the dog.

Please keep me posted and let me know if there’s anything I can do to help.

I agree. Suppressing the immune system rather than treating the underlying cause seems inappropriate, though my husband’s family have very hyperactive immune systems – 2 close relatives with RA, one with MS and 2 more with asthma and serious food allergies. And on the subject of allergies, I did take my son to a naturopath last year who did an IgG food antibody assessment – what do you know about the validity of such tests? He showed high reactions to citrus and garlic, moderate to eggs, and low to very low for wheat, spelt and dairy. The naturopath said his UC patients kept their symptoms in remission by avoiding those foods they reacted to. He was not able to convince my son to do an elimination/rotation diet (he can be his own worst enemy). Also is there a test for celiac disease or is it just an elimination trial?
My son’s doc is a highly respected member of the GI dept. at a large teaching hospital in NH. Immunosuppresion seems to be the treatment of choice at most if not all conventional medical centers from what I have read; a Canadian friend said her GI doc has an aggressive drug, not diet, approach to treating her UC too. This is not the path I would have chosen, but I’m having to accept that my son is old enough to take ownership of his health. I will continue to give him alternate information in the hopes that he will change his attitude at some point.
I really appreciate the opportunity to pick your brain Paul, and I thank you for your thoughts and suggestions.

Yes, he’s a good doctor in the practice of conventional medicine, but I am increasingly disillusioned by the emphasis on expensive treatment and drugs at the expense of listening to the body. I have become very cynical about the role of pharmaceutical companies.
Perhaps I should have said “finely-tuned” immune systems rather than hyperactive. At least that’s what I tell my son, that his body is more finely-tuned than some and less tolerant of poor dietary choices…
I continue to visit your site regularly and enjoyed your book very much. Thank you again for sharing your knowledge.

My friend has a family history of IB/Chron’s. He said he can’t tolerate red meat due to the condition. I’m wondering if it’s cross contamination from the grains he is likely eating with his meals that contain red meat. Red meat consumption should be no issues with IB/Crohn’s correct?

I was wondering if those two people in your life who developed UC (who you reference at the beginning of this post)actually ended up following PHD (+ recommendations?) and if things improved for them? I’m trying hard to figure out my path to healing UC but I’m having a pretty hard time keeping all of this (excellent!) info straight.(It’s not because you aren’t clear, I think my brain is foggy) I currently follow PHD eating for the most part and my intention is to also get into the supplement routine. One problem is that I don’t go more than a few days without troublesome symptoms like blood or loose stools, so I don’t really know how I’m going to tell if a supplement is compatible or not.

Hi Paul,
I’m still working at trying to figure out how to help myself with Ulcerative colitis and it looks like my boat was sinking faster than I could bail. I did the Metametrix stool test but they rejected it. It’s possible the medication I take interfered. Anyways, I’ve ended up in hospital with this and of course I am under the care of a doctor. I have to continue on with where I’m at which unfortunately this week turned into an immune suppressing drug, steroids and blood transfusions.

I’m hoping to be kicked into remission and get myself back onto eating properly. I’m still very confused about carbohydrates. I fortunately don’t have the heartburn/gas/bloating symptoms. One of my Metametrix tests (organic dysbiosis I think) pointed towards SIBO. I feel a whole lot better when I eat PHD but because of the possible/likely SIBO I try to go along with the GAPS/SCD idea about depriving those specific carbs. I think those diets are too extreme for me at the moment since things ended up plummeting downhill.

You also suggested to me that I am likely dealing with some possible upper digestive issues.

I’m so lost and confused and as you read, quite ill. My plan, once I get out of the hospital is to start out with PHD + supplements+ enzymes+ Betaine hydrochloride+ a probiotic called VSL#3 which has been clinically shown to achieve remission for UC.

Sorry to hear of your setbacks. It’s too bad the doctors are so ineffective at treating these conditions. Have you considered asking for a fecal transplant?

Your plan sounds like a good one, since you seemed to do well on PHD. Every digestive tract ailment is different so you have to find the diet that works best for you. Often it’s SCD-like but sometimes PHD works better.

Potatoes are a generally very healthy food for the gut but their fiber can feed bad microbes. Glycoalkaloid content is highly dependent on how the potatoes were handled; it can be quite low if the potatoes were kept in cool dark conditions continuously after harvest, and the skin was not broken. I would suggest peeling and dicing potatoes, removing any discolored areas and discarding any potato with substantial discoloration. Get potatoes as fresh as you can and maintain them yourself in dark conditions.

I think you just have to test the safe starches and see if you tolerate them. Many people with UC do best with no starch at all. You can still get adequate carbs by eating simpler sugars, eg dextrose powder.

Yes I made an attempt to get in an FT clinical trial but you have to relocate to the area and my personal circumstances don’t make that possible for the moment. I don’t have anyone who is close enough and healthy enough to do it myself, but I’m always scouting. There was this good news I read this morning

So to incorporate dextrose, I would substitute an equal amount of calories and incorporate it in desserts or sauces? Is rice syrup also a substitute? Would you start experimenting by substituting all dextrose/ rice syrup and just figuring out how much starch you can bring back in?

I sure do appreciate your help, it is frustrating to know of all the advances happening with gut diseases and the only thing a doctor will /can do is deliver the standard of care- steroids and immunosuppressors. Here in (under serviced) Canada it’s even harder. I can’t even get LDN prescribed.

Hey Paul! Big fan of your book and blog. Here is my story, I’m 20 years old and took a course of antibiotic last winter for acne (biggest mistake I ever done). Cleared the acne but gave me gut symptoms. Went on a very low carb diet for 5 month and now I’m here severely underweight, malnutritioned, hypothyriod (low t3) with impaired immunity and a pseudonomas aeruginosa bacterial infection and a blastocytis hominis parasitic infection. My stool test also showed no good bacteria in the gut. Have started working on my immunity (Vit C, NAC, Selenium+ Iodine+ K2+Vitamin D+ Great lakes Gelatin powder). A hair analysis showed high copper so I will do some blood tests to see how I need to supplement, I know both zinc and copper are crucial. Also high ferritin levels. Trying to optimize circadian rythm but often wakes up at least once every night. Taking probiotics to repopulate my gut. I’ve started adding starches to help the immune system and try to not lose more weight. I’m hungry all the time, I think the parasite makes me glucose deficient… I have acid reflux and burp a lot after meals. Brain fog is also a big problem. How do you think I should tackle this? I’m working with a practioner who hopefully will help me with the treatment. How do you think I should tweak my diet (carbs,fat, protein, supplements) and lifestyle to get my life back? Is fasting a good idea? And what do you think of antibiotics vs natural treatments in this case? I’m doing some lauricidin at the time to keep the bacterial level down until I’ve talked to my doctor. I would really appreciate your thoughts. Thanks!

Hallo Shou- Ching and Paul,
first I have to say sorry for my bad english, I´m working on it consequently. 😛

Second I want to thank you for all your inspiring work, the blog- posts about bowel disorders and so on. You dramatically changed my life (and with it the lifes of many more people). I´m a psychologist und physiotherapist who works with ibs- clients. I always mention your book and website in my sessions, but most patients hope for a german version in the near future.

Our self- help community http://www.reizdarmtherapie.net is also inspired by you, Chris Kresser and some other nice people. I hope you´ll visit good old Europe in the future, I would be glad to meet you and thank you personally for helping to “cure” my terrible ibs-d!

But do you think the liver could also play a bigger role in this whole picture? It’s the main synthesizer and detoxifying organ. They say everything you eat, drink and breathe passes through it. Whether it’s some covert injury, dysfunction or circadian disruption?

Transplant-acquired allergies are common, especially after liver transplant. I’m sure it’s more complicated than it seems – but do you think this could be a hint, that we should focus on liver health just as much, or even more than on gut health?

I’ve suffered for years, on and off, but found when I improved my diet and lifestyle UC practically became a thing of the past.

I’ve recently had my first attack in 20 years and was really struggling to get it under control. I lost over a stone and became anaemic and weak. I’m now following the Specific Carbohydrate Diet and it’s made such a difference. This diet, as well as prednidolone enemas twice per day have really helped it to settle down.

Hi Paul, I started PHD in 2016 with myriad symptoms and no meaningful diagnosis. Most docs ticked the box for a syndrome or two – Fibro, IBS, etc. I’ve tried everything. Low FODMAPs, nightshade elimination, AIP, herbals, supplements. I’d like to share what finally cured me — because it’s free: A 10 day water fast. If you have IBS and are interested, I’ve assembled the studies that persuaded me and links to other bloggers who inspired me:

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